17^th World Congress on Infection Prevention and Control June 07-08, 2021 Berlin, Germany

Biography:

Virendra Rawat is the originator of Global Green Schooling Concept, recognized by United Nations as Global Solution, which is listed on UN Global Innovation Exchange. His Green Schooling concept is creating a community of Nature Champions Worldwide.He has addressed the Harvard University and United Nations on Sustainable Practices in Education.  He is also recipient of UNGA Award - 2019 for his contribution towards promoting UN SDG No. 4. He also hosted first national Conference on Hygiene and Infection Control with association of City University of New York. He is the author of Diploma on Hygiene and Infection Control in India. He has trained more than 500 Certified Hygiene and Infection Control Auditors in India.

Abstract:

Garment

Garment is the second skin of our body, is of immense importance in human life and has been evolved continuously.

Skin

Skin is also largest sense organ in the human body. It can act as a barrier as well as a medium for entry of biological toxins and pathogens in the body.

Pathogens

When pigments toxins and chemicals present in the environment get accumulated in the conventional garment and may enter into the body through the skin, hence, enhancing skin’s ability to resist entry of harmful chemicals and toxins into the body will improve the health.

How it works

Antibacterial & Antiviral herbal treatment of clothing provides medicinal value to the garment and protection against myriad biological toxins and pathogens to the Skin.

When herbal treated antibacterial & antiviral garments are worn, the medicinal property in the garment is then transferred to the skin.

The herbal molecules of the treated garment enter deep into the body, show its effects at different levels of the body, and help in protecting body from biological toxins and pathogens.

The skin can act not only as a protective barrier but also as a medium for outside substances to enter into the body. In the same way, the skin has the ability to absorb herbs present in the treated garment.

These herbs release their medicinal qualities in the body and strengthen the skin’s ability to block and resist the biological toxins and pathogens.

Biography:

Riffat Shaheen is from Karachi, Pakistan and working since more than in the field of IPC, QA, and Healthcare management. Currently Working as consultant QA and IPC with National Institute of Blood Diseases (NIBD) in Karachi.

Abstract:

Ventilator associated pneumonia (VAP) is the most common hospital acquired infection among patient in intensive care unit and is associated with significant mortality rate and rising the cost of care by increasing a patient’s stay (Babcock, 2004). In the month of August 2017 at Tertiary Care Hospital, HAI surveillance system was modified to see that how many patients received hospital acquired pneumonia from ventilator and was identified that 61.2 cases per 1000 ventilated days got VAP which was a leading cause to increase a patient’s stay with ventilator that was almost 8 days. Several standards of care have been developed in attempt to reduce the occurrence of VAP rate and patient stay with ventilator by developing a VAP committee with inclusion of purchase manager to get a right item with required amount for implementation of IPC practices & biomedical managers for medical equipment maintenance to reduce infection rate.

Purpose

1. The 1st purpose of all exercise, to implement a HAI surveillance system in a right manner    with described time frame.

2. The 2nd purpose was that, 50% reduction of hospital acquired VAP rate and patient stay with ventilator by the end of December 2017.

3. The 3rd purpose to observe current practices of nursing staff and doctor on patient with mechanical ventilator in critical care units.

4.The 4th purpose to identify the gape for improvement in IPC related practices to reduce the VAP rate. 

5. The 5th purpose of this study to see the benefit of supply chain and biomedical managers’ inclusion in VAP committee to reduce a VAP rate.

6. The 6th purpose was that to train all concern people who participate directly or indirectly with maximum and minimum percentage and can contribute in reduction of hospital acquired infection in a future by putting their right efforts.

Methodology:

Setting: Observation was conducted in all intensive care units including medical, surgical and pediatric, consist of 51 beds, at tertiary care hospital.

Population: All patients who are connected to a ventilator after admission. All register nurses and attending doctor are assigned on patient with ventilator.

Inclusion Criteria: All patients who developed a VAP, connected to ventilator for more than 48hours and within 48hours after disconnection of ventilator. Exclusion Criteria: None.

Selection criteria: High risk, high cost, high volume, problem prone and requirement of standard such as IPC and ISO.

Design: That was retrospective and concurrent study.

Data Collection: Collected by making a daily round in all intensive care units, reviewed patient’s clinical condition, and their medical records and reviewed all investigation reports such as x-ray, sputum C/S, CBC. Status of ventilator’s cleaning, PPM and calibration. Supply related respiratory therapy, hand hygiene and PPE such as suction catheter, HME filter, soap, hand rub were reviewed for the specification and inventory management with coordination of purchase department.

Data Analysis: Patients’ data was compiled on excel sheet & mini-tab. Pre and post swim lane & value stream map were prepared  on evaluation of staff practices as six sigma project.    

Results

Initially as a base line, just observed the current practices and knowledge of the healthcare workers and surveillance systems conducted by IPC team from July to August 2017. During baseline phase, it was observed no coordination among ICU’s stakeholder, IPC team, purchase and bio-medical department. All healthcare worker involved in care on ventilated patient, were educated on VAP bundle, hand hygiene and appropriate using of PPE. VAP committee was established with including of purchase manager and bio-medical manager to purchase right items for use and appropriate cleaning, PPM and calibration. Hand hygiene compliance monitoring systems were introduced. HAI surveillance system was modified. Initially it was based on positive culture reports only. HAI key performance indicators were introduced. All interventions produced improvement and Hospital acquired VAP were reduced from 61.2 to 24.0 cases per 1000 ventilator days. The compliance of IPC practices such as hand hygiene, changes of gloves, proper technique of suctioning, use of RO water for oxygen therapy, oral hygiene, head elevation and humidifier disinfection were improved from 39.2 to 87.8%. The mean of patient’ stay with ventilator were reduced from 6.38 to 4.01 and standard deviation was reduced by 34.9% (p<0.05).

Conclusion:

Conduction of HAI surveillance system is a first necessary step for IPC team there for it is essential that HAI surveillance system must be perform with a right direction to get a correct rate of hospital acquired infection as it will reflect on IPC’s work competency. These whole exercises concluded that by improving of hand hygiene, changing of PPE from one use to another use, VAP bundle implementation, using of RO water for oxygen therapy, avoiding contamination during suction and cleaning and disinfection of oxygen humidifier can play a major role. Another important factor was identified that people who can have indirect relation with less percentage can play a major role to achieve big percentage of compliance.  Preparation on monthly VAP indicator will capture the attention of concern stakeholders for continuity of improvement

 Limitations:

Initially, implementation of surveillance system with modification was very tough for IPC team as they were not habitual, nor they had a detail concept so there was a possibility to have under reporting system as it been a new for IPC team.

Monitoring of VAP bundle’s implementation, changing of gloves from one use to another use and hand hygiene practices were challenging for IPC team sometimes they were missing observation.

Purchase department managers were not cooperative on initial phase as they had a concept of no need to discuss with IPC team and VAP committee before purchasing any item

Bio-medical department has a same thought regarding PPM and calibration schedule of ventilator.

Biography:

Ganga Pilli is Presently working in KLE University’s JN Medical College and KLES Prabhakar Kore  Hospital, Belagavi, Karnataka State, India.

Abstract:

Introduction: Hydrops fetalis is a severe fetal condition characterized by an abnormal collection of fluid in pleural, peritoneal and pericardial cavities. Hydrops can result from diverse etiologies. It has been classically divided into immune and nonimmune hydrops. Determining the cause can save the fetus in subsequent pregnancies.

Case Report: A 22 years old female, multi-gravida presented with five months amenorrhoea.

Antenatal ultrasound scan was performed which revealed evidence of generalized edema of whole body of fetus.  She gives history of a non - consanguineous marriage.  Per-abdominal examination revealed 19 weeks and 5 days gestation. Ultrasound examination showed single intrauterine gestation. Amniotic fluid was adequate. Generalised subcutaneous edema was noted. Fetal parameters were noted and final impression was intrauterine death with hydrops fetalis. Maternal laboratory findings were within normal limits. Her blood group was “B positive” and husband’s blood group was “AB positive”. Antibody screening test was negative. Maternal serum titres for toxoplasmosis, rubella, cytomegalovirus, parvovirus, syphilis were negative. Medical termination of pregnancy was done was done and a still born fetus was delivered which was sent to the department of pathology for fetal autopsy.

Material and Methods: Fetus of 19 weeks 5 days gestation with placenta and attached umbilical cord was received for autopsy. A incision of Y shaped was taken and autopsy was performed. Thorax and abdominal cavity were opened in layers. Fluid was noted in thoracic and abdominal cavity amounting to 3cc and 8cc respectively. Fluid accumulation was also noted in the subcutaneous tissue. All the organs were found in situ. Heart and other organs did not reveal any anomalies.  Organs were examined histopathologically. Skin and subcutaneous tissue revealed excess accumulation of fluid and vessels showed nucleated RBCs. No viral inclusions were noted. Placenta was un remarkable. No other cause could be identified. Final impression of a female fetus with 19 weeks 5 days of gestation with non-immune hydrops fetalis without any congenital anomalies was given.

Conclusion: To conclude, a post-mortem evaluation should be performed in all cases of hydrops fetalis that result in neonatal death. A combined approach of a thorough antenatal assessment and autopsy may be more likely to determine the cause of non-immune hydrops.

Biography:

Seyed Saeed Nabavi is Presently working in Tehran Azad University, Iran

Abstract:

Pain nerve fibers would be developed at the age of 22 to 29 weeks in the fetus. However, the response to the pain is different between term and preterm infants.

That pain is the cause of behavioral and physiological responses in infants. The physiological response includes increased blood pressure, heart rate, cranial pressure, tachycardia, tachypnea, apnea, and sweating.

On the other hand, the behavioral response includes crying, frowning, and body and extremities movement.                                                            

Several evaluation methods are usually implemented for pain studies, such as premature infant pain profile (PIPP) or behavioral pain scale (BPS), or neonatal infant pain scale (NIPS).          

Furthermore, a myriad of methods and drugs would be used for pain management in infants, the most significant of which are silence area, massage therapy, skin contact or administration of acetaminophen, fentanyl, and opioids.

It is also worth mentioning that one of the most non-pharmacological drugs is the dextrose solution.     

Methods and Materials                                                       

In this cross-over trial, a randomized placebo-controlled study was performed on 50 well-term neonates (male: 27 and female: 23).

We compared 5cc dextrose solution with 5cc distilled water (placebo) orally in interval one-day blood sampling.

Infant response against pain stimulants evaluated with NIPS, consisting of crying severity, face mood affect changes, body and extremity movements, and pulse rate. 

 (P-value <0.05)

Conclusion                                                                                   

This study demonstrates that administrated dextrose decreases crying severity and causes less   mood affect change.

However, it does not prevent  heart rate changes  (bradycardia and tachycardia) and does not prevent body and extremity contraction in painful procedures.

Biography:

Dr. Shyamapada Mandal, Professor, Department of Zoology, and Dean (Faculty of Science) University of Gour Banga, India, is interested on infectious diseases, probiotics, and genomics, bioinformatics, and in silico drug development research. He did pre-PhD, PhD, and post-PhD research under the guidance of Professor Nishith Kumar Pal at Calcutta School of Tropical Medicine, India. He has published 117 articles with eight book chapters. He is life member of IAMM and IASR, India, and fellow member of SASS, India. Eight national academic and research awards have been conferred to him. He has guided 52 post graduate students; supervised three MPhil and three PhD students. Professor Mandal is among the world’s top 2% scientists as per the survey of the Stanford University, published in PLOS (Public Library of Science) Biology (October, 2020).

Abstract:

Mucormycosis is a rare but serious fungal infection caused with mucormycetes (Rhizopus oryzae (or Rhizopus microsporus), Mucor species, Lichtheimia corymbifera and Rhizomucor pusillus), and is currently associated COVID-19 as ‘black fungus’ causing high mortality. This communication states the inhibition of target proteins of Rhizopus microspores by some bioactive phytochemicals following in silico approaches. Therefore, we have docked the phytochemical ligands cajanone, diosgenin and piperine, along with the standard treatment isavuconazole to X-ray diffraction structure (obtained from RCSB Protein Data Bank) of two target proteins rhizopuspepsin and lipase from Rhizopus microsporus var. chinensis, in order to determine the binding affinity of the ligands to the receptors. The four ligands cajanone, diosgenin, piperine and isavuconazole had respective binding energy of −9.1, −8.7, −7.8 and −7.3 kcal/mol to rhizopuspepsin, and −7.6, −8.1, −6.6 and −7.1 kcal/mol, displaying hydrogen bonds and/or hydrophobic interactions.The drug-likeness, bioavailability and ADMET properties were determined for the ligands intended to be utilised as the candidate drugs against Mucorales infection and thereby preventing ‘black fungus’ during COVID-19 pandemic.

Biography:

Riffat Shaheen is from Karachi, Pakistan and working since more than in the field of IPC, QA, and Healthcare management. Currently Working as consultant QA and IPC with National Institute of Blood Diseases (NIBD) in Karachi.

Abstract:

All staffs who are working in deferent departments of any healthcare facility have a significant value to carry out the effective implementation of healthcare management in a hospital. At the situation of COVID-19 pandemic outbreak, all healthcare workers are at on high risk to acquire the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may increase the result of harm while caring of patients in a hospital however they can get severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from their family and community as well. The first case of COVID-19 was reported in Wuhan, China in December 2019 and in Pakistan, the first case of COVID-19 has been confirmed by the Ministry of Health, Government of Pakistan on February 26, 2020, in Karachi, Sindh province. From 8th March 2020, we had started to work on the management of COVID-19 pandemic in our healthcare setup where we had started our triage room, crowed control mechanisms, designated route, and all other strategies implementation. Besides all upcoming patients, we had started to monitor all healthcare works for their practices and clinical status for preventing further spread of COVID-19 and had taken immediate actions as were needed.

Purpose

1. To establish a system of Contact Tracing of all healthcare workers in the hospital.

2. To early identification of a person with signs and symptoms of COVID-19 among Healthcare Workers.

3. To establish a system for the diagnose of exposed and symptomatic healthcare workers, based on their clinical status and test reports.

4. To create a system for the home isolation, and rerun to work for the contacted and symptomatic healthcare works.

5. To build a system for the monitoring of their clinical status in the duration of home isolation. The overall purpose is to create effective strategies that should be easily implemented and accepted by all in overcoming the COVID-19 pandemic situation.

Methodology:

Setting: Observation was conducted in all units including Inpatient Units, Emergency Room, Triage Room, OPD, Day Care, Housekeeping, Laboratory, X-Ray, Ultra Sound, Passive Immunization, Reception, Security, Food Service Department, Pharmacy, Purchase, IT (Information and Technology) Marketing, Account, Transport and Admin units at a specialized hospital.

Population: All Staffs including clinical and non-clinical who are working in the hospital. Inclusion Criteria: All staff who a history of contact with any has suspected or confirm COVID-19 patient in hospital, family & friend circle, and community.

Selection criteria: high risk, high cost, high volume, problem-prone and requirement of IPC

Design: That was the Prospective Observational Study

Data Collection: Collected by making a daily round in all units, Risk Assessment tool of COVID-19 which was used in triage clinic for scoring based on their clinical status and history of contact, tracing list of contacted healthcare works (HCWs), reviewed HCWs’ clinical condition and discussed with the triage doctor about their clinical status, and daily follow-up their status via phone and SMS and investigation reports such as x-ray and RT-PCR.

Data Analysis: Patients’ data was compiled on an excel sheet.

Results 

In the COVID-19 pandemic situation, we started our management with the establishment of triage room on 8th March 2020 including dedicated staff for all 3 shifts, and initially, we started to monitor their health status but later it was extended to other units including clinical and non-clinical. Before Eid-ul-Fiter only one staff was identified with COVID -19 symptoms but after Eid Holidays we got 3 staff with symptoms and on the 2nd day we got more staff with COVID symptoms. We modified our strategies immediately, distributed the formal tracing list of contacted HCWs and official memo to all units with requests to extend their cooperation with IPC team. As per the tracing list, 180 staffs out of 300, were identified with the history of contact with suspected or confirmed case in the hospital, family, friend circle or in community and it was impossible to quarantine 60% staffs, therefore, we implemented the policy that after contact with suspected or confirmed case + symptomatic staffs will be remained in home isolation and those staff also with positive PCR due to any reason. From 27th May till the end of July 2020, 33.3% of staff had developed the symptoms and 75 staffs were in home isolation with the percentage with 24.0% because they met the criteria of the COVID-19 Risk Assessment tool. Out of 75, 26.3% staffs are belonged to the laboratory, on 2nd number is from nursing services which is 22.3%, doctors are on 3rd number with 11.8% and the rest of other departmental staff have less than 10%. All staffs were developed symptoms of fever (F), cough (C), difficulty of breath (SOB), diarrhea (D), sore throat (ST) body ache (BA), weakness, and flu (FL) during their isolation period. 13.3% of staffs were remained asymptomatic till 14 days as their PCR test was positive and 86.7% of staff developed symptoms. On follow-up by Infection Prevention and Control (IPC) team during 14 days isolation period, it was noticed that 20% staffs were developed minor or moderate to severe symptoms, 3.3% staff had a situation from server to minor or moderate symptomatic conditions on initial 5 -10 days, 28.3% of staff always informed about their symptomatic condition on follow-up and but on the day of reassessment by the triage doctors they were clinically fit. The 6.7% staff remained a challenge because they did not inform their clinical status via any mode of communication. Healthcare workers (HCWs) develop different type of symptoms 63.1% with fever, 60% with body ache, 53.8% with cough, 33.8%with shortness of breath, 26.2% with weakness, 15.4% with sore throat, 3.1% diarrhea and 1.5% with flu as alone or with combination of COVID-19 symptoms in home isolation period.

Conclusion:

Proper handling of the COVID-19 pandemic situation was very challenging for anyone as an institution, as an IPC team and as an individual too. There were no established guidelines on a national and international level and after every few days, we were receiving new guidelines and were confused that what should be the final strategy. However every day we learned something good for the future and to prevent our hospital team as they are assets of any healthcare facility especially in the situation of the outbreak of any infectious diseases. The best strategies are to teach them, establish the criteria for the tracing list of contacted healthcare workers, effective implementation of home isolation and strict monitoring system for their clinical status.

Limitations:

There were lots of challenges we had faced as mentioned below:

1. On initial stage staff and departmental HODs were not cooperative and they were reluctant

to inform that they had contact with suspected or confirm COVID-19 patients in their family, friend circle, and community.

2. Departments were reluctant to fill the tracing list and send it to IPC department as they had fears and doubts in their minds.

3. There had been many changes in national and international guidelines.

4. Management was reluctant to quarantine of contacted healthcare workers.

5. RT-PCR test could not be formed all contacted healthcare workers due to cost issues and for symptomatic staffs due to the unavailability of kit in market and cost as well that who should paid .

6. Vigilant follow-up of contacted healthcare workers for their clinical status till 14 days was quite challenging for the IPC team besides other IPC activities which needed to be carryout as smoothly as demand.

Biography:

Virendra Rawat is the originator of Global Green Schooling Concept, recognized by United Nations as Global Solution, which is listed on UN Global Innovation Exchange. His Green Schooling concept is creating a community of Nature Champions Worldwide.He has addressed the Harvard University and United Nations on Sustainable Practices in Education.  He is also recipient of UNGA Award - 2019 for his contribution towards promoting UN SDG No. 4.

He also hosted first national Conference on Hygiene and Infection Control with association of City University of New York. He is the author of Diploma on Hygiene and Infection Control in India. He has trained more than 500 Certified Hygiene and Infection Control Auditors in India.

Abstract:

The COVID-19 pandemic continues to evolve, Hygiene and Infection Control Audit and Germs Free Certification for all Outdoor Learning, Working, Trading, Manufacturing, Health Caring, Travelling, Staying and Eating Spaces free form the fear of  infections .Everyone is  society is eagerly looking for the solutions to respond Covid-19 by making working spaces more safer than ever before.

Hygiene & Infection Control Audit and GERMS FREE SPACES Certification brings power to occupants to Learn, Work Travel, Stay and Eat Safe and Fearless environment by making all working spaces  clean conducive and virus protected.

Keeping this in mind, Green Mentors offers Hygiene and Infection Control Audit  of all Working Spaces including Learning, Trading, Manufacturing, Health Caring, Travelling, Staying and Eating Spaces to respond the Challenges of Covid-19 by offering Safe and fearless environment  through  GERMS FREE SPACES Certification.

GERMS FREE SPACEs assures every member to learn, work travel, stay and eat Safe with confidence and also assure their families to send their loved one to outdoor space without any fear.

Hygiene & Infection Control Audit is a set of hygiene Safety and infection prevention indicators for Outdoor Spaces. Each safety and prevention indicator is in turn measured against a set of objective of Global Standards for safe working spaces fo fearless working.

Biography:

Nahid Batarfi is from Infection control and prevention department, Aldiriyah hospital, Riyadh, Saudi Arabia.

Abstract:

Candida Auris, since its first isolation in 2009, is being considered an emerging fungal pathogen and a global health threat. Recently there has been growing concern regarding drug resistance, difficulty in identification, as well as problems with eradication. Invasive candida infections or candidemia causes increased morbidity and mortality. Knowing that, multi-resistant candida, such as C. Auris, can cause challenges in diagnosis and treatment potentiating the risk of death. During pandemics, short of supply of personal protective equipment (PPE), as well as overcrowded hospitals, have led to breaches in infection control practices, leading to outbreaks of multi-drug resistant organisms, including C. Auris. Although outbreaks have been reported throughout the other hospitals in the region (1,2,3), no previous reports on C. Auris – COVID-19 co-infections and its effect on patient’s outcome.

Research Problem:2 o During the current COVID-19 pandemic, coinciding with the increasing expansion of ICU COVID-19 patients, nosocomial spread of multi-resistant pathogens like Candida Auris is a potential infection control threat. Identification of the potential source and assess the impact of interventions provided is vitally needed. o In our institute, we had couple of patients with culture positive for C. Auris resulting in an outbreak. Recognizing the factors associated with poor patients’ outcome is necessary. • Research Objectives: o Primary Objective: â–ª To investigate the incidence of Candida Auris infection or colonization among hospitalized ICU’ patients who had a laboratoryconfirmed COVID-19 infection, between June 2020 to May 2021. o Secondary

Objective: â–ª Identify the demographic and clinical features associated with poor outcome in the same patients’ group compared to control cases.

• Method: o Design: â–ª Chart review, single-center, retrospective, 1:3 case-control study. Cases with positive culture for Candida Auris will be matched in 1:3 ratio to control cases with no C. Auris in terms of 1) gender, 2) the age range of 10 years, 3) date of admission range of 7 days. 

Setting: â–ª This study will be performed in the COVID-19 units in the intensive care department of a newly established public hospital in Riyadh, Saudi Arabia. These units were established in the response to increasing critical care demand during the peak of COVID-19 cases 3 in the country. Cases in this unit are received from other hospital and are only accepted if they had laboratory confirmed COVID-19 infection prior to transfer with the need to critical care services. The 60-bed department consisted of three separate critical care wards (Burn unit, CCU and MICU), each prepared with 20 beds.

â–ª The three COVID-19 units were equipped with all the necessary personal protective equipment (PPE) as well as hand hygiene precautions. All COVID-19 patients are placed under the contact and droplet isolation when admitted to the unit, while put under airborne isolation if undergoing aerosol generating procedures or while hooked to mechanical ventilation. A High-Efficiency Particulate Air (HEPA) filter is used when Airborne Infection Isolation Rooms (AIIRs) were not available. All health care providers were required to have basic training in infection control principles.

o Inclusion/Exclusion: Between June 2020 and May 2021, all adult (>18 years) patients with laboratory confirmed COVID-19 infection and had any culture specimen positive for C. Auris from blood, urine, respiratory tract, skin and/or other sites. Cases with incomplete data will be excluded from the analysis. o Data source and collection: â–ª Patients’ data will be extracted from the patients’ medical records. Using a standardized data collection sheet, a trained health care provider will collect the patients’ demographic, patient location, the patient history, risk factors for candidiasis (central venous catheter, use of broad-spectrum antibiotics, complicated abdominal surgeries, total parental therapy, neutropenia, acute renal failure, active malignancy), 4 the basic laboratory, microbiological data (including first negative culture), length of stay, ventilator days, and therapeutics provided.

â–ª Relevant data on all admitted patients: Total admissions, total positive cultures, total candida positive cultures, average length of stay. o Study definitions:

â–ª Invasive candida infection (ICI): Isolation of candida species (C. Auris) from at least one sterile body site in presence of symptoms and/or signs of infections.

â–ª Health care associated blood stream infection (HCA-BSI): after 48 hours of admission, the first isolation of Candida species (C. Auris) from a blood culture in a patient with symptoms and/or signs of infection.

â–ª Candida colonization: positive culture of Candida species (C. Auris) from non-sterile body sites without symptoms and/or signs of infections. o Microbiology:

â–ª Different types specimens were collected and processed according to the CLSI standards in an outside laboratory with biosafety level 2. Following necessary incubation conditions, staining by gram stains is performed and followed by culture on blood, MacConkey, chocolate, and Sabouraud agar, and identification by Vitek-2. The antimicrobial sensitivities will be performed manually (E-test) and automatically (Vitek 2) o Study outcome:5

â–ª Death at 30 days following specimen collection date.

â–ª Ventilator days. â–ª In-hospital length of stay. o Statistics:

â–ª Labeling and data entry into the SPSS version 27 software will be followed. Data will then be cleaned and organized into different variables to be prepared for analysis. Basic analysis will be used, such as frequencies and cross-tabulations for demographics, microbiology and clinical outcomes.

â–ª The method of analysis was chosen to achieve the aim and objectives of the study. Assessment of association between study variables and study outcome will be obtained by Chi-square test as needed.

o Anticipated limitations: â–ª Total number of pathogens exceeds total number of blood cultures and that’s because a single culture might have more than one isolate. â–ª Some difficulties will be during recognizing community acquired, and health-care acquired infection, and this will be overcome by doing more investigations

â–ª Patients who were being under broad spectrum antibiotic can affect their culture results and this is will be resolved by knowing types of antibiotics used and an infectious disease consultant will be consulted to decide the spectrum affects

â–ª Missing data, will be resolved by digging more about the information.

6 Sample of data collection sheet:

Serial number

Cases or control?

Sex/age

Site of infection

ICU stay before infection

DOI

Intubation/ ventilated

Indwelling urinary catheter

Presence of CVC

Broad spectrum antibiotics

Outcome

DOOutcom

Biography:

Dr. Shyamapada Mandal, Professor, Department of Zoology, and Dean (Faculty of Science) University of Gour Banga, India, is interested on infectious diseases, probiotics, and genomics, bioinformatics, and in silico drug development research. He did pre-PhD, PhD, and post-PhD research under the guidance of Professor Nishith Kumar Pal at Calcutta School of Tropical Medicine, India. He has published 117 articles with eight book chapters. He is life member of IAMM and IASR, India, and fellow member of SASS, India. Eight national academic and research awards have been conferred to him. He has guided 52 post graduate students; supervised three MPhil and three PhD students. Professor Mandal is among the world’s top 2% scientists as per the survey of the Stanford University, published in PLOS (Public Library of Science) Biology (October, 2020).

Abstract:

Among the aging people neurodegenerative disorders including Parkinson’s disease is of great concern, because of lack of standard cure, and side effects of the currently available medications treating the symptoms of the disease. This suggests the need of new medication for Parkinson’s disease. Brahmi (Bacopa monnieri), a neuroprotective herb, plays a vital role in the treatment of cognitive and aging related disorders, in Ayurvedic medicine. We have assessed Bacopa monnieri bioactive compounds to decipher the inhibition capacity against Parkinson’s disease protein, compared to the currently available Parkinson’s disease medicine, levodopa, by ADMET analysis, molecular docking and dynamic simulation studies. To achieve this goal, we have performed docking of four Bacopa monnieri derived chemical compounds, such as brahmic acid, rosavin, wogonin and oroxindin, compared to levodopa (3D structures downloaded from PubChem), to human catechol O-methyltransferase (hCOMT: PDB ID: 3BWM). The docked protein-ligand complex generated binding energy of -6.6, -7.2, -7.2, -7.7 and -6.1 kcal/mol for brahmic acid, rosavin, wogonin, oroxindin and levodopa, respectively, against hCOMT through hydrogen bond formation and hydrophobic interactions. We have also performed molecular dynamic simulation to authenticate the formation of thermodynamically stable protein-ligand complex due to low free binding energy, and checked the quality of hCOMT structure through Ramachandran plot analysis. Based upon the drug-likeness property, oral bioavailability and ADMET profiles of the Bacopa monnieri derived chemical ligands might be useful in the preparation of biotherapeutics for Parkinson’s disease. 

Biography:

Clare is the Lead Case Management Pharmacist for Intermediate Care in Belfast Health & Social Care Trust and is an integral member of the Medicines Optimisation in Older People(MOOP) Pharmacy team. Her role involves reviewing medicines use in older people to address polypharmacy and ensure an evidence-based approach to prescribing. Clare links closely with multidisciplinary teams and primary care services and delivers education sessions on a range of topics pertinent to medicine use in older people.

Abstract:

Self-Administration of Medicines (SAM) involves the service user looking after and taking their prescribed medication whilst staying in a healthcare facility. To enable service user confidence and autonomy in medicine taking and identification of medication adherence issues prior to discharge, a SAM scheme was piloted and evaluated in Chestnut Grove Older People’s Intermediate Care(IC) facility (May 2019). Enabling service users to take their medicines safely and effectively has been a longstanding challenge for health and social care. The need to support people to remain independent and self-manage their medicines where possible is underpinned by NI Department of Health and national NICE Medicines Optimisation guidelines^1,2

Currently service users in Intermediate Care facilities have their medication administered by care staff, during prescribed medication rounds.

The consequences of this practice include:

• Service users lose independence and confidence

• Service users become deskilled

• Medicine adherence issues are not identified and no solutions/help provided

• Increased requirement for care packages & compliance aids

Outcome measure:

• % of service users self administering medication

Process measure:

• No. of staff receiving SAM training
• % compliance with SAM assessment/protocol
• No. of staff who receive training reporting an increase in confidence in SAM

Balance measure:

•  Adverse incidents with patients who self administer e.g. wrong dose or poor compliance
• Impact on staff workload

Process Measures:

• 40 service users were originally enrolled in the pilot with 34 successfully undertaking SAM
• 100% of staff within Chestnut Grove completed the required SAM training
• Staff were 100% compliant with completion of SAM assessment/protocol
• All care home staff overseeing patients participating in SAM Strongly agreed/ Agreed that SAM:
  • Improved patient knowledge and familiarity with their medicines
  • Educated and empowered patients to take responsibility for their medicines
  • Increased patient independence

Balance Measures:

• During the SAM project there were no reported Adverse Incidents
• Staff were neutral about the impact of SAM on their workload.

Learning & impact on Service users/Staff

Medicines Adherence issues identified & addressed:

Six service users had to withdraw from SAM. Engagement with SAM identified adherence issues of service users who previously required no assistance at home with medication. This enabled appropriate support to be put in place on discharge e.g. referral to adherence pharmacist for follow up in the Community.

Reduced necessity for initiating compliance aids

Positive service user feedback; 100% patients Strongly agreed/Agreed that:

• SAM gave them the chance to become more familiar with their medicines
• SAM made them feel more independent
• They would want SAM as choice on admission to a healthcare facility

Challenges & Learning

• Low number of eligible service users in unit during pilot (No. of beds reduced due to staffing)
• Storage/access to medications in safe (mobility/vision)
• Staffing/resources limiting changes/project
• Regular education/ communication is key to achieve change

Developments:

• SAM Protocol approved by BHSCT Standards and Guidelines Committee 2020
• Engaging with regional Medicines Optimisation Older People(MOOP) pharmacy team to support SAM implementation

Future plans:

• Cascade the learning to other BHSCT service areas
• Offer SAM as routine for all eligible patients in Chestnut Grove
• Evaluate the financial impact of SAM

References

1.NI Medicines Optimisation Quality Framework 2016 www.dhsspsni.gov.uk

2.NICE Guideline NG5: Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes 2015

Biography:

Peter Sabaka has completed his PhD at the age of 29 years from Comenius University in Bratislava, Faculty of Medicine in Bratislava, Slovak Republik. He is the associate profesor and physician at the Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava. He has published more than 30 papers in reputed journals.

Abstract:

Clostridioides difficile infection (CDI) the most common casue of nosocomialdiarrhea. Faecal microbial transplantation (FMT) is the most effective treatment of recurrent CDI. However, many patients experience further recurrences after first course of FMT. The raeasons for FMT failure and its risk factors are unclear. Comorbid status is a risk factor for failure of farmacotherapy of the reccurent CDI and it might be associated with the risk of FMT failure as weell.

We carried out a prospective observational cohort study in order assess the association of comorbid status and FMT failure. Patients with recurrent CDI underwent FMT via retention enema and were followed up for 12 weeks for signs and symptoms of CDI recurrence. FMT failure was defined as recurrence of diarrhoea and a positive stool test for the presence of C. difficile antigen or toxin  during the follow-up. We assessed the association of single FMT failure with possible manageable and unmanageable risk factors. Charlson Comorbidity Index (CCI) was used to quantify the comorbidity.

A total of 60 patients (34 women, 26 men) were included in the study. Overall, 15 patients (25%) experienced single FMT failure. O patients with CCI ≥ 7, 50% experienced FMT failure compared to 6.67% of those with CCI below 7. Patients who experienced single FMT failure had a significantly higher CCI and significantly lower albumin concentration as compared to patients who experienced single FMT success. There was no difference in age, C-reactive protein concentration, leukocyte count and time from FMT to first defecation. In multivariate analysis, CCI ≥ 7 was positively associated with the FMT failure. In conclusion, cmorobid status is associated with the high risk of FMT failure in the treatment of reccurent CDI.

Biography:

Huang Wei Ling, born in Taiwan, raised and graduated in medicine in Brazil, specialist in infectious and parasitic diseases, General Practitioner and Parenteral and Enteral Medical Nutrition Therapist. Once in charge of the Hospital Infection Control Service of the City of Franca’s General Hospital, she was responsible for the control of all prescribed antimicrobial medication and received an award for the best paper presented at the Brazilian Hospital Infection Control Congress (1998). Since 1997, she works with the approach and treatment of all chronic diseases in a holistic way, with treatment guided through teachings of Traditional Chinese Medicine and Hippocrates. 

Abstract:

Introduction: The hospital infections (HI) in paediatrics patients are important causes of morbidity and mortality in podiatric hospitals. The incidence of nosocomial infections in this population is 2,5% in one study.

Purpose: is to demonstrate that the use of some kinds of diets (Cold water and cow´s milk) and the influence of some external pathogenic factors (Wind, Cold, Humidity, Heat, Dryness) can influence the development of hospital infection in paediatrics patients and the avoidance of some kinds of foods and the observation and controlling the entrance of the external pathogenic factor in the body of the child can reduce or control the hospital infection symptoms.

Methods: two cases reports: one baby girl born on April 11, 2003,the nurses took the first bath of this baby in front of the open window in the night during the bath. When the baby was taken to the mother's room, her nose was running and making the first breast feeding difficult. The second case was a 3 years-old boy who was admitted in the hospital due to knee pain and fever. The orthopaedic doctor said that probably was an infection in the knee and did procedure to drain the abscess and started the use of intravenous antibiotics. The patient’s grandmother said that even with the use of antibiotics, the fever does not reduce and called to an infectious disease doctor with background in traditional Chinese medicine. The doctor orientates by telephone to do not allow the use of cold water, caw´s milk and close the windows, mainly during the night when the children is sleeping, and protecting all the skin with light clothes.

Results: the first case improves the cold symptom when the mother cover the baby and protects from the Wind and Cold. The second case improved the fever and the drainage of the secretion after following the recommendations avoiding dairy products, cold water and closing the windows.

Conclusion: in pediatric patients, it is very important to consider the influences of diet and the entrance of external pathogenic factors as inducers of hospital infection and the orientations and control of the entrance of these factors inside the body of the patient is crucial for controlling the symptoms of hospital infection.

Biography:

Huang Wei Ling, born in Taiwan, raised and graduated in medicine in Brazil, specialist in infectious and parasitic diseases, General Practitioner and Parenteral and Enteral Medical Nutrition Therapist. Once in charge of the Hospital Infection Control Service of the City of Franca’s General Hospital, she was responsible for the control of all prescribed antimicrobial medication and received an award for the best paper presented at the Brazilian Hospital Infection Control Congress (1998). Since 1997, she works with the approach and treatment of all chronic diseases in a holistic way, with treatment guided through teachings of Traditional Chinese Medicine and Hippocrates. 

Abstract:

Introduction: The definition of immunocompetent by Western medicine is that when the patient has not any virus immune deficiency or using any drugs such as corticosteroids, immunosuppressant, chemotherapy, etc or any metabolic disease such as diabetes, chronic renal or hepatic disease and or the presence of malignancies. Other conditions such as radiations or the presence of heavy metals can also be considered in this case.  In other studies, they are demonstrating the importance of importance to address which could be the mechanism involved when some people categorized as immune competent begin to have diseases that only immunosuppressive patients have.

Purpose: the purpose of this study is to demonstrate that the majority of the patients that are hospitalizing in the hospital are classified as immunosuppressive patients.

Methods: through a research that author did in her clinic in Brazil, from 2015 to 2020, she measured 1000 chakras’ energy centers and from this group, she could analyze 409 files.

Results: in this study, 90% of her patient were in the lowest level of energy meaning that their immune system were very compromised because energy in TCM means immune system. In some studies, they are demonstrating that the cause of the energy deficiency could be the exposition to the electromagnetic radiation by the 5G technology,

Conclusion: the conclusion of this study is that the majority of the patients that we are hospitalizing nowadays could be in the immunosuppressant category and the treatment of this patients replenishing the chakras’ energy centers using homeopathy medications before hospitalizing , when not urgent, could be one of the possible tools used by the physician to reduce complications and the kind the medications used in this patients that have low energy inside the chakras’ centers could be one of the tools to increase the energy, reducing in this case , the formation of hospital infections or any other noninfectious problems such myocardial infarction, strokes, hyperglycemia, etc  and also, the increase in the incidence of hospital infections in all these patients induced by wrong eating habits and wrong kinds of medications (the use of excessive highly concentrated medications are responsible for the reduction even more the vital energy, leading to the formation of internal heat, increasing the hospital infections symptoms.